Mukesh Shanthilal1, Sathya Maruthavanan2
BACKGROUND This study is aimed to evaluate the effect of fluconazole on prevention of oral candidacies and in reduction of severity of oral mucositis induced by radiotherapy. METHODS The study was conducted on 48 head and neck cancers patients. Cases were randomised into study (22/48) and control groups (26/48). Both groups received radiotherapy with or without chemotherapy. Oral swabs were collected before start of radiation three weeks later and at the end of radiation. Oral swabs were cultured for candidial growth. Study group patients received oral fluconazole 50 mg/day throughout the course of radiation and control group patients received no fluconazole prophylaxis. Patients were examined weekly for oral mucositis and were graded according to CTC version 2.0.
RESULTS Oral swabs were taken from all patients before start of radiotherapy showed candidial growth in 22.9% (11/48). During the course of radiation treatment, oral candidial culture was positive in 42.3% (11/26) of control group patients and 40.9% (9/22) of study group (p=0.644). There was statistically significant reduction in the severity of mucositis in the study arm (p=0.021). In the study arm, there was grade 0 in 27.2% (6/22), grade 1 in 27.2% (6/22), grade 2 in 31.8% (7/22), grade 3 in 22.7% (5/22), and no grade 4. In the control arm, there was no grade 0 noted, grade 1 was seen in 19.2% (5/26), grade 2 in 61.5% (16/26), grade 3 in 15.3% (4/26), and no grade 4. Patients in whom candidial culture was negative had less severe mucositis as compared to patients with positive candidial culture (p=0.029). CONCLUSION Prophylactic use of oral fluconazole is effective in reducing the severity of oral mucositis by reducing oral candidiasis.